“Decision to Enrol or Not in Health Insurance Scheme”: Views from North Tongu District (Ntd)

Mutual Health Insurance Schemes (MHIS) have been developed and promoted as mechanisms to offer protection to poor households from the risk of ill-health, death and loss of assets. However, the introduction of the North Tongu Mutual Health Insurance Scheme (NTMHIS) witnessed some mixed feelings and mistrust for political reasons and fear about the workability of the scheme due to experience with collective arrangements. Surprisingly, therefore, within its three year implementation period, the scheme recorded an impressive coverage of about fifty percent of the entire population. However, little evidence exists to explain reasons for this surprise at the district level. The study investigated why households enrolled in the NTMHIS to that extent. The study arrived at evidence which suggests that the ability of enrolled households of North Tongu District (NTD) to construct a link between their choice for insurance and the trust they have in both the scheme management and service providers emanates from the fact that their expectations are being met and this, coupled with the fact that premium is within the reach of majority, contributed significantly to the increase in enrolment in the NTMHIS. Additionally, innovative public education strategy and balanced power relations within most households and preference for insurance to user fees have all explained why people enrol in the NTMHIS. The study, however, found that, in spite of government’s effort at bringing premium within the reach of majority and her relief package for the core poor, some category of households still remain excluded due to lack of cash to pay. Scepticism among non-enrolled households, which was also partly bred by the failure of some enrolled households to participate in some sensitization activities of the scheme; hostile attitude of some health staff, and previous experiences with collective arrangements all explained why others remain uninsured. It is suggested that to ensure generally improved access to health care for majority, Government should consider focusing on preventive health to 12 avoid possible premium increase that has the potential to exclude many more households in the scheme, sensitization programmes must be critically evaluated and bureaucracy in registration process minimized. There is the need also for service providers to be given adequate training to demonstrate high level of professionalism in the discharge of their duties. Besides, government should not only modify the relief package for the core poor but also ensure that those who have still been excluded due to lack of cash to pay are brought on board by paying premium in kind, using their farm produce. Finally, NTMHIS is to tailor its marketing strategies to cater for those with less or no education as a way of improving access to care for many more households. Relevance To Development Studies : ‘Health, it is said, is Wealth’ Unfortunately, the major development challenge facing greater population around the globe especially in low and middle income countries is inaccessibility to health care, occasioned by problem of health care financing. It is hoped that when factors that contribute to the surprisingly high enrolment in the new initiative in a typically low income environment like NTD is unravelled all other areas, for that matter, countries, will emulate and improve access to health care for their people.